Medicare Advantage Guidelines

Medicare Advantage or Part C is a type of insurance plan that is provided by private insurance companies. Even though you can get Medicare parts A and B from the government, many people opt to go with Medicare Advantage plans instead. If you choose this type of plan, there are some guidelines that you should understand.

Required Coverages

• Medicare is broken up into different plans that provide different benefits. Medicare Part A is hospital insurance that is offered directly by the federal government. Once you turn 65, you are automatically enrolled in this program unless you opt out. Medicare Part B is a plan that helps with doctor expenses. If you choose a Medicare Advantage plan, the provider must automatically provide all of the same benefits as the Part A and B coverage.

Appeal

• Even though you purchase a Medicare Advantage plan from a private insurance company, that does not necessarily mean that you give up rights that you would have if you purchased from the government. For example, you still have the right to appeal decisions made by the insurance company. If you do not like a decision that is made, you can file an appeal and your case will be heard.

Options

• You can choose between several different plan options when choosing a Medicare Advantage plan. These plans give you multiple options to consider, including prescription drug coverage and lower deductibles or co-pays. Evaluating your own medical needs can help you make the right decision when it comes to choosing a Medicare Advantage plan. You may want to choose a plan with a higher deductible or co-pay so that your premiums are lower.

Types

• Insurance companies offer different types of networks and plans for Medicare Advantage. For example, you could sign up with a preferred provider organization or a health maintenance organization. With HMOs, you can only see doctors and facilities that are in your network. Many times, you also have to get a referral to see a specialist. With a PPO, you can choose any doctor or facility you want, but you will pay less for in-network providers.

Considerations

• When choosing a Medicare Advantage plan, it is important to look at all of the different options that are available. You can choose the co-pay you want to have, the annual deductible and potentially the network in which you would like to receive service. You also can choose a plan that helps with the cost of your Medicare Part B monthly premium. It also is important to determine if your plan as an annual limit.